Aortitis pathophysiology

Aortitis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Aortitis is a term used to describe inflammation of the aortic wall.

Pathophysiology

Inflammatory Aortitis

Giant cell arteritis and Takayasu arteritis are associated with inflammatory cellular infiltrate of the aortic media, adventitia, and vasa vasorum. Eventually scarring of the aortic media and destruction of the elastic lamina may occur. On microscopic histopathological analysis, granuloma formation, a tree-bark appearance, and multinucleated giant cells may be seen in either Takayasu arteritis or Giant cell arteritis. On microscopic histopathological analysis, extensive intimal and adventitial fibrosis and scarring with resultant luminal narrowing are characteristic findings of aortitis due to Takayasu arteritis. Extensive medial inflammation and necrosis is a characteristic finding on microscopic histopathological analysis of aortitis due to giant cell arteritis.

Infectious Aortitis

The majority of cases of bacterial aortitis are due to bacteria seeding through a segment of the aortic wall with existing pathology via the vasa vasorum. Tuberculous aortitis occurs due to miliary spread or as a result of direct seeding of the thoracic aorta from adjacent infected tissues. Syphilitic aortitis most commonly involves the ascending aorta. The classic histopathological finding in syphilitic aneursym is a “tree barking” appearance of the aortic intima. Inflammatory involvement of tertiary syphilis begins at the adventitia of the aortic arch which progressively causes obliterative endarteritis of the vasa vasorum. This leads to narrowing of the lumen of the vasa vasorum, causing ischemic injury of the medial aortic arch and then finally loss of elastic support and dilation of the vessel.

References

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